Field of the Invention
The invention generally relates to surgical devices for heart valve repair and, more particularly, relates to an instrument for repairing an atrioventricular heart valve, in particular the mitral heart valve, in open heart surgery (surgery of the drained heart, accessed through the split sternum, via an incision or sternotomy, minithoracotomy or from another direction). The invention further relates to an instrument set and to a surgical method.
Description of Related Art
Prolapses of a leaflet of the mitral valve into the left atrium and resulting valve insufficiency can cause serious dysfunctions of the heart. One reason for such prolapse is a damaging of the tendons (chordae tendinae) that connect the leaflets of the mitral valve to the papillary muscle through the left ventricle. Such a damage may, for example, be a result of a myocardial infarction or as a consequence of degenerative valve disease.
A repair of such a prolapse demands the leaflet or leaflets to be re-connected to the papillary muscle, for example by synthetic chords, such as Gore-tex® fibres.
There have been proposals to use minimally invasive techniques for the treatment of atrioventricular valve prolapses. US 2004/0003819 teaches to treat the prolapse by grasping two leaflets by a catheter and clamping them together. Also US 201070042147 teaches techniques of introducing a surgical suture by means of a catheter to treat this kind of prolapse. US 2008/195126 teaches methods for repairing the heart that are based on an anchor to be attached to the papillary muscle and a suture that is attached to the anchor and, for example, the leaflet or other place in the heart. WO 2012/040865 teaches approaches for temporary leaflet stabilization in minimally invasive surgery.
However, for the minimally invasive techniques, the temporary stabilization of the tissue portions in which implants are placed is still a challenge. Thus, open heart surgery is still preferred for carrying out atrioventricular valve repair operations. However, in open heart surgery, the handling and implantation of the very small implants used for these operations is still a challenge. Also, according to the state of the art, the leaflet is sutured to the implanted artificial chord, this demands high skills from the surgeon and is time consuming. Suturing of both sides (papillary muscle and leaflet) is challenging and not well defined and thus a challenge to surgeons.